Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb kwv yees tias ob txhiab tus neeg thoob ntiaj teb muaj tus kab mob latent, thiab kwv yees li peb lab tus tib neeg thoob ntiaj teb tuag los ntawm tuberculosis txhua xyoo. Kev kuaj tubercle bacillus tseem hu ua tuberculin test lossis PPD (purified protein derivative).
Kev xeem mantoux yog dab tsi?
Qhov no yog ib qho kev sim siv los txiav txim seb tus neeg puas tau tsim cov tshuaj tiv thaiv kab mob rau cov kab mob uas ua rau tuberculosis (TB). Cov tshuaj tiv thaiv lub cev no tuaj yeem tshwm sim yog tias ib tus neeg muaj TB tam sim no, yog tias lawv tau kis rau yav dhau los, lossis yog tias lawv tau txais cov tshuaj tiv thaiv BCG rau TB.
YTuberculin test
Kev kuaj tawv nqaij tuberculin yog raws li qhov tseeb tias tus kab mob tuberculosis induces ib ncua-hom hypersensitivity cov tshuaj tiv thaiv rau qee yam ntawm cov kab mob. Lub cev Cheebtsam yog muab rho tawm los ntawm tuberculosis kab lis kev cai thiab yog lub ntsiab tseem ceeb ntawm classic tuberculin PPD. Cov khoom siv PPD no yog siv los kuaj. Cov tshuaj tiv thaiv nyob rau hauv daim tawv nqaij rau tuberculin PPD pib thaum cov tshuaj tiv thaiv kab mob tshwj xeeb hu ua T hlwb tau rhiab heev los ntawm tus kab mob yav dhau los,nyiam los ntawm lub cev tiv thaiv kab mob mus rau thaj tsam ntawm daim tawv nqaij uas lawv tso cov tshuaj hu ua lymphokines. Cov lymphokines induce induration (qhov chaw nyuaj nrog cov npoo zoo ntawm thiab ib ncig ntawm qhov chaw txhaj tshuaj) los ntawm cov vasodilation hauv zos (nthuav dav ntawm txoj kab uas hla ntawm cov hlab ntsha), uas ua rau cov kua dej deposition hu ua edema, fibrin deposition, thiab recruitment ntawm lwm yam. inflammatory cells rau thaj tsam.
Lub sijhawm incubation ntawm 2 mus rau 12 lub lis piam feem ntau yuav tsum tau tom qab kis tus kab mob TB rau kev kuaj PPD kom zoo. Txhua tus tuaj yeem kuaj tus kab mob TB, thiab nws tuaj yeem ua rau cov menyuam mos, cov poj niam cev xeeb tub lossis cov neeg muaj HIV yam tsis muaj kev phom sij. Nws tsuas yog contraindicated nyob rau hauv cov neeg uas tau muaj ib tug hnyav tshuaj tiv thaiv rau ib tug yav dhau los tuberculin daim tawv nqaij kuaj.
Kev kuaj kab mob TB zoo li cas?
Tus qauv pom zoo kev kuaj tuberculin, hu ua Mantoux test, yog tswj hwm los ntawm kev txhaj tshuaj 0.1 ml ntawm cov kua uas muaj 5 IU (tuberculin units) ntawm PPD rau hauv cov khaubncaws sab nraud povtseg ntawm daim tawv nqaij (intradermally, hauv qab ntawm qhov chaw ntawm lub cev. daim tawv nqaij) ntawm forearm. Nws raug nquahu kom siv thaj chaw tsis muaj qhov tsis txaus ntseeg thiab los ntawm cov hlab ntsha. Kev txhaj tshuaj feem ntau yog muab siv 27-gauge koob thiab tuberculin syringe. Tuberculin PPD yog txhaj ncaj qha rau hauv qab ntawm daim tawv nqaij. Nrog rau kev txhaj tshuaj kom zoo, ib qho kev sib cais, daj ntseg ntawm daim tawv nqaij nce ntawm 6-10 mm nyob rau hauv txoj kab uas hla yuav tsum tau tsim. Qhov "npuas" no feem ntau yog absorbed sai. Yog tias nws tau txiav txim siab tias thawj qhov kev xeem tau nkag mus tsis raug, lwm qhov yuav raug muab tam sim ntawd.
Kev ntsuas qhov tshwm sim
Kev ntsuas qhov ntsuas mantoux hauv cov menyuam yaus thiab cov neeg laus txhais tau tias kuaj pom qhov siab, tuab hauv cheeb tsam ntawm cov tawv nqaij hu ua induration. Cov ntsaws ruaj ruaj yog lub hauv paus tseem ceeb los xyuas kom meej tias cov txheej txheem ua tiav kom raug. Nws yog ntseeg yuam kev tias nyob rau hauv cov ntaub ntawv no redness los yog bruising tshwm sim. Kev ntsuam xyuas ntawm daim tawv nqaij yuav tsum tau ntsuas 48-72 teev tom qab txhaj tshuaj, thaum qhov loj ntawm lub pob yog qhov siab tshaj plaws. Cov kev sim nyeem tom qab yuav muaj qhov tsis raug compaction loj thiab tsis nqa cov ntaub ntawv txhim khu kev qha.
Yuav txhais li cas rau kev kuaj tawv nqaij?
Lub hauv paus rau kev ntsuas qhov tshwm sim ntawm qhov kev sim mantoux yog qhov muaj lossis tsis muaj qhov ntim ntawm induration (localized qog). Txoj kab uas hla ntawm lub foob yuav tsum ntsuas transversely (xws li perpendicularly) mus rau qhov ntev axis ntawm lub forearm thiab kaw nyob rau hauv millimeters. Cov cheeb tsam ntawm kev sib sau ua ke nyob ib ncig ntawm qhov chaw txhaj tshuaj yog cov tshuaj tiv thaiv rau tuberculin. Nws yog ib qho tseem ceeb kom nco ntsoov tias qhov liab tsis ntsuas.
Tuberculin cov tshuaj tiv thaiv yog cais raws li qhov txiaj ntsig zoo ntawm kev ntsuas mantoux nyob ntawm txoj kab uas hla ntawm lub foob nrog rau qee yam kev pheej hmoo rau tus neeg mob. Hauv ib tus neeg noj qab haus huv uas nws lub cev tiv thaiv kab mob tsis zoo, qhov kev tiv thaiv ntau dua lossis sib npaug ntawm 15 mm yog suav tias yog qhov txiaj ntsig zoo. Yog tias muaj hlwv (vesiculation) tshwm sim, qhov kev ntsuam xyuas kuj pom zoo.
Nyob hauv qee pawg neeg, qhov kev ntsuam xyuas pom tau tias yog qhov zoo yog tias muaj pob tsawg dua 15 hli. Piv txwv li, ib cheeb tsam sealing ntawm 10 mmsuav tias yog qhov zoo hauv cov tib neeg hauv qab no:
- Cov neeg tsiv teb tsaws chaw tsis ntev los no los ntawm thaj chaw uas muaj tus kab mob TB ntau heev.
- Cov neeg nyob hauv thiab cov neeg ua haujlwm hauv thaj chaw muaj kev pheej hmoo kis tus kabmob.
- Tshuaj.
- Cov menyuam yaus hnub nyoog qis dua 4.
- High-risk me nyuam cov neeg mob.
- Cov neeg ua haujlwm nrog cov kab mob mycobacteria hauv cov chaw sim.
A 5 mm foob tau pom zoo rau pawg hauv qab no:
- Cov neeg uas nws lub cev tiv thaiv kab mob raug txwv.
- HIV.
- Cov neeg uas muaj kev hloov pauv pom ntawm lub hauv siab x-ray uas zoo ib yam nrog TB yav dhau los.
- Kev tiv tauj tsis ntev los no ntawm cov neeg muaj tus kab mob TB.
- Cov neeg uas tau hloov lub cev.
Ntawm qhov tod tes, qhov kev kuaj tsis zoo mantoux tsis yog ib txwm txhais tau tias tus neeg tsis muaj tuberculosis. Cov neeg uas tau kis tus kab mob no yuav tsis muaj qhov zoo ntawm daim tawv nqaij (paub tias yog qhov tsis zoo) yog tias lawv lub cev tiv thaiv kab mob raug cuam tshuam los ntawm kev mob ntev, kev kho mob qog noj ntshav, lossis AIDS. Tsis tas li ntawd, 10-25% ntawm cov neeg uas tau kuaj pom tus kab mob pulmonary tshiab kuj tseem yuav kuaj qhov tsis zoo, tej zaum yuav yog vim lub cev tsis muaj zog, noj zaub mov tsis zoo, kis kab mob sib kis, lossis kev kho steroid. Ntau tshaj 50% ntawm cov neeg mob uas muaj tus kab mob TB dav dav (kis mus thoob lub cev, hu ua tub rog TB) kuj yuav kuaj tsis zoo rau TB.
Tus neeg uas tau txais cov tshuaj tiv thaiv BCG tiv thaiv kab mob kuj tuaj yeem muaj cov tawv nqaij zoo, txawm tias qhov no tsis yog ib txwm muaj. Qhov no yog ib qho piv txwv ntawm qhov txiaj ntsig tsis zoo. Cov tshuaj tiv thaiv zoo tshwm sim los ntawm cov tshuaj tiv thaiv tuaj yeem nyob tau ntau xyoo. Cov uas tau txhaj tshuaj tom qab thawj xyoo ntawm lub neej los yog cov uas tau txhaj tshuaj tiv thaiv ntau tshaj ib zaug yuav muaj qhov txiaj ntsig zoo mus tas li ntau dua li cov uas tau txhaj tshuaj thaum cev xeeb tub.
Cov neeg uas kis tau lwm hom kab mob mycobacteria uas tsis yog Mycobacterium tuberculosis kuj tseem tuaj yeem kuaj cov tawv nqaij tsis zoo.
Contraindications thiab ntsuas
Mantoux xeem contraindications yog raws li nram no.
Kev siv tuberculin-derived protein derivative, PPD, tsis tso cai rau cov neeg mob uas muaj kev tsis haum tshuaj yav dhau los rau tus neeg kuaj mob lossis ib yam ntawm nws cov khoom.
Ntxiv rau, vim muaj peev xwm ua rau muaj qhov hnyav dua, qhov kev sim ntawm daim tawv nqaij tuberculin yuav tsum tsis txhob muab rau txhua tus neeg uas yav dhau los tau ntsib cov tawv nqaij hnyav xws li vesiculation, ulceration, lossis necrosis.
Thaum siv cov khoom siv roj ntsha, tus kws tshuaj lossis kws kho mob yuav tsum tau ceev faj kom tsis txhob muaj kev fab tshuaj.
Tus neeg ua haujlwm kho mob yuav tsum tau txhaj tshuaj epinephrine (1: 1000) thiab lwm yam tshuaj uas siv los kho tus mob hnyav anaphylaxis yog tias muaj kev phiv loj heev.
Ua ntej ua qhov ntsuas mantoux, cov kws kho mob yuav tsum qhia tus neeg mob, niam txiv,Tus neeg saib xyuas lossis tus neeg laus muaj lub luag haujlwm txog cov txiaj ntsig thiab kev pheej hmoo ntawm qhov kev paub dhau los. Tus neeg mob lossis tus neeg laus muaj lub luag haujlwm yuav tsum tshaj tawm cov tshuaj tiv thaiv tsis zoo tom qab tus txheej txheem.
tshuaj tiv thaiv
Tus TB-purified protein derivative, PPD, yog rau kev siv intradermal nkaus xwb. Nws tsis yog muab los ntawm kev txhaj tshuaj, intramuscular lossis subcutaneous tswj hwm. Yog tias nws tau muab los ntawm ib txoj hauv kev uas tsis yog intradermal, lossis yog tias ib feem tseem ceeb ntawm cov tshuaj xau los ntawm qhov chaw txhaj tshuaj, qhov kev ntsuam xyuas tau rov ua dua tam sim ntawd, tsawg kawg 5 cm ntawm qhov chaw txhaj tshuaj thawj zaug.
Nyob rau tus kab mob
Cov neeg mob uas muaj kev tiv thaiv kab mob tseem ceeb yuav tsis teb txaus rau tuberculin-derived protein antibody, PPD daim tawv nqaij kuaj. Immunosuppressive neeg yog cov neeg mob:
- nrog tus kab mob neoplastic generalized;
- nrog cov kab mob cuam tshuam rau cov kab mob qog nqaij hlav (Hodgkin's disease, lymphoma, chronic leukemia, sarcoidosis);
- nrog cov kab mob ntawm lub cev tiv thaiv kab mob cuam tshuam los ntawm kev kho corticosteroid nrog ntau tshaj li kev siv lub cev, tshuaj alkylating, tshuaj tiv thaiv metabolite lossis kev kho hluav taws xob.
Tuberculin cov tshuaj tiv thaiv ntawm daim tawv nqaij yuav raug txwv tsis pub dhau 5 lossis 6 lub lis piam tom qab tso tseg corticosteroids lossis tshuaj tiv thaiv kab mob. Lub sijhawm luv (tsawg dua 2 lub lis piam) corticosteroid therapy lossis intra-articular, bursal, lossis tendon txhaj nrog corticosteroids yuav tsum tsis txhob ua.immunosuppressive.
Kab mob
Tuberculin Purified Protein Derivative, PPD Skin Test (Tubersol) yuav tsum tsis txhob siv rau cov neeg mob uas paub tus kab mob ntsws (TB) lossis muaj keeb kwm meej ntawm kev kho TB. Lub xub ntiag ntawm tus kab mob tuaj yeem ua rau lub cev tsis muaj zog tiv thaiv kab mob ua rau muaj kev ntxhov siab rau cov tuberculin-tsim protein derivative, PPD daim tawv nqaij kuaj. Tus neeg ua tus txheej txheem yog qhia kom paub txog qhov tsis zoo-tsis zoo tuberculin cov tshuaj tiv thaiv hauv cov neeg mob uas muaj tus kab mob kis tam sim no (tus kab mob herpes, qhua pias, mumps, varicella), kab mob kab mob, kab mob fungal, kab mob tua kab mob, lossis hauv cov neeg mob tau txhaj tshuaj tiv thaiv nrog qee qhov. tshuaj tiv thaiv kab mob nyob. Nws raug nquahu kom kuaj cov tawv nqaij tuberculin rau ntawm qhov chaw sib cais, lossis 4-6 lub lis piam tom qab txhaj tshuaj.
Lwm yam kab mob
Txo rov ua rau tuberculin-tsim protein derivative, PPD daim tawv nqaij kuaj yuav tshwm sim rau cov neeg mob uas muaj tus kab mob sib thooj lossis mob uas cuam tshuam kev tiv thaiv ntawm tes. Cov tshuaj tiv thaiv tuberculin tsis zoo yuav tshwm sim hauv cov neeg mob ntshav qab zib; nrog rau mob raum tsis ua haujlwm; nyob rau hauv cov neeg mob uas muaj protein ntau tsis txaus noj (> poob phaus=10% ntawm lub cev hnyav) raws li ib tug tshwm sim ntawm malabsorption syndrome, tag nrho gastrectomy los yog bypass phais; los yog nyob rau hauv cov neeg mob uas muaj kev ntxhov siab xws li kev phais, kub hnyiab, mob hlwb, los yog kev tshwm simvs kev hloov pauv.
Acquired Immune Deficiency Syndrome (AIDS), Human Immunodeficiency Virus (HIV)
Cov neeg uas muaj tus kab mob asymptomatic lossis cov tsos mob ntawm tib neeg kev tiv thaiv kab mob HIV (HIV) yuav muaj cov lus teb tsis txaus rau cov tshuaj tiv thaiv kab mob rau tuberculin-tsim protein derivative, PPD daim tawv nqaij kuaj. Cov txiaj ntsig ntawm daim tawv nqaij ua rau tsis tshua muaj kev ntseeg siab hauv cov neeg muaj kab mob HIV vim tias CD4 suav txo qis thiab nce mus rau qhov kev tiv thaiv kab mob tiv thaiv kab mob (AIDS). Kev kuaj yuav tsum tau ua sai li sai tau tom qab kuaj pom tus kab mob HIV. Tsis tas li ntawd xwb, vim tias cov kab mob TB (TB) tuaj yeem loj hlob sai hauv cov tib neeg uas muaj kab mob HIV, kev kuaj tawv nqaij ib ntus raug pom zoo rau cov neeg mob HIV uas muaj feem yuav kis tau tus kab mob TB.
Kids
Mantou xeem tau ua tiav rau txhua pawg hnub nyoog. Txawm li cas los xij, cov menyuam mos thiab menyuam mos=5 hli hauv cov menyuam mos thiab cov menyuam yaus uas raug tus kab mob TB raug suav hais tias yog qhov zoo. Tsis tas li ntawd, cov menyuam yaus hnub nyoog qis dua 4 xyoos uas muaj kev pheej hmoo kis mob tau suav tias yog qhov zoo yog tias daim tawv nqaij compaction qhab nia yog > 10 mm. Rau tag nrho lwm cov menyuam yaus uas muaj kev pheej hmoo tsawg, kev ntsuas kev cog lus ntawm >=15mm yog qhov zoo.
cov neeg laus
Kev nkag siab rau tuberculin-tsim protein derivative, PPD daim tawv nqaij kuaj yuav txo qis nrog lub hnub nyoog thiab hnub nyoog. Cov neeg mob Geriatric tsis tuaj yeem tos txog 72 teev rau kev kuaj pom, yog li kev ntsuas ntsuas tom qab 48 teev yuav tsis xav tau. Daim tawv nqaij kuaj tsis kam >=10 mm yog suav tias yog ib qho kev kuaj mantoux zoo hauv cov neeg mob laus.
Kev cev xeeb tub
A tuberculin-purified protein derivative, PPD yog cais raws li FDA Pregnancy Risk qeb C. Tsis muaj kev tshawb fawb txaus, tswj tau zoo hauv cov poj niam cev xeeb tub; Kev tshawb fawb tsiaj yug tsiaj tsis tau ua. Nws tsis paub tias kev tswj hwm ntawm tuberculin daim tawv nqaij kuaj puas tuaj yeem ua rau muaj kev puas tsuaj rau tus menyuam hauv plab los yog cuam tshuam rau kev ua me nyuam. End Tuberculosis Advisory Board ntseeg hais tias kev ntsuam xyuas ntawm daim tawv nqaij tuberculin siv tau thiab muaj kev nyab xeeb thaum cev xeeb tub. Hom kev sim no tsuas yog siv thaum cev xeeb tub yog tias qhov txiaj ntsig zoo rau leej niam pom tseeb qhov kev pheej hmoo rau tus menyuam hauv plab.
Pub mis niam
Tsis muaj ntaub ntawv los ntawm cov chaw tsim khoom hais txog kev siv tuberculin-proteined protein derivative, PPD, hauv cov niam mis. Txawm li cas los xij, vim qhov kev ntsuam xyuas tsis muaj cov kab mob nyob lossis cov kab mob kis tau los yog cov kab mob, qhov kev pheej hmoo rau tus menyuam mos yog qhov tsawg. Cov txiaj ntsig ntawm kev pub niam mis, kev pheej hmoo ntawm kev cuam tshuam rau cov menyuam mos noj zaub mov, thiab kev pheej hmoo ntawm kev kho tsis zoo lossis tsis kho yuav tsum raug txiav txim siab. Yog tias kev pub niam mis rau tus menyuam mos muaj qhov cuam tshuam tsis zoo cuam tshuam nrog rau niam txiv cov tshuaj, nws raug nquahu kom tus neeg ua haujlwm saib xyuas kev noj qab haus huv ua qhov kev tshawb fawb qhia txog qhov tsis zoo.
Duab ntawm kev xeem mantoux hauv kab lusqhia tau hais tias nws yuav tsum saib li cas thiab ntsuas nws kom raug li cas thiaj li tau txais txiaj ntsig zoo. Tsis muaj cov lus pom zoo rau cov txheej txheem. Qhov kev so no tsis tas yuav muaj kev noj zaub mov tshwj xeeb, muab cov cwj pwm tsis zoo, thiab lwm yam. Yog tias muaj kev xav tias muaj tuberculin bacillus nyob hauv lub cev, nws yuav tsum tau mus ntsib kws kho mob tshwj xeeb. Nws yuav sau cov kev tshawb fawb tsim nyog thiab xaiv cov kev kho mob uas tsim nyog.
